Updates in Pediatrics  

May 27, 2015   Vol. VI, Issue 21
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Septic arthritis and acute rheumatic fever in children - serological inflammatory markers.

"Joint pain and raised inflammatory markers are features of both acute rheumatic fever (ARF) and septic arthritis"


A retrospective hospital database study of all children <16 years of age admitted with a diagnosis of ARF or septic monoarthritis over a seven year period which noted baseline clinical characteristics, serological inflammatory markers and serum white cell counts (WCC) indicates:


Children presenting with an ESR >64.5, serum WCC <12,100 and age >8.5 years have a 71% risk for ARF vs. 29% risk for septic arthritis.


Journal of Pediatric Orthopaedics

Tongue tie and frenotomy in infants with breast feeding difficulties.

Debate continues as to how best manage the young infant with tongue-tie who is breast feeding, as outcomes to assess treatment benefits are subject to significant subjectivity. Prevalence rates vary significantly (0.02% to 10.7%).


A review of a number of databases which examine the benefit of tongue-tie release on breast feeding (316 normal infants < 3 months of age) enrolled in frenotomy RTC's across 5 studies suggests that frenotomy appears to improve breast feeding, preferably being performed between 2 to 3 weeks of age (50% of babies with ankyloglossia will not have any breast feeding problems). Complications are rare when performed by trained professionals.


Archives of Diseases in Children

Isolated linear skull fractures in children with blunt head trauma.

A secondary analysis of a large prospective study of 43,904 children (25% <2 years of age) yielded 350 with an isolated linear skull fracture and a Glasgow coma score of 14/15. 70% were secondary to falls (81% <2 year olds); 62 had repeated head computed tomography (CT) or magnetic resonance imaging (MRI) with a occasional new findings, but none requiring surgical intervention.


Children with minor blunt head injury and an isolated linear skull fracture are at very low risk for evolving other findings or requiring neurosurgical intervention. Monitoring in hospital is typically unnecessary.





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Demographics and treatment of adolescent post traumatic headache (PTH)/concussion.


Mild traumatic concussion affects over 1 million children



A medical records review of 400 post-concussive children (age 13-18 years) suggests that:


1.    Females are more likely to report post traumatic headache, receive amitriptyline treatment (most with improvement) and have significantly longer recovery time (80 days vs. 34 days for males).


2.    Male players of other sports report similar number of headaches compared to football players.


Pediatric Neurology 

Therapeutic hypothermia (TH) in children after cardiac arrest.


TH is apparently beneficial following hypoxic-ischemic brain injury (encephalopathy-HIE) in neonates and adults. It has not been well studied in children.


A systematic review of TH in children following HIE from a number of databases (1946-2014), found just 6 studies (3 retrospective and 3 prospective cohort studies) which fulfilled fairly stringent inclusion criteria.


From the limited amount of data available, mortality in TH treated children with HIE appears to be 44% with 28% having poor neurological outcomes. Evidence appears insufficient at present to support the routine use of TH in the resuscitation of HIE children


Pediatric Emergency Care 

Video Feature

via YouTube


Tongue-Tied: Helping Babies Breastfeed
Tongue-Tied: Helping Babies Breastfeed

Use cell-free DNA (cfDNA) to screen for Down's syndrome.


"Standard prenatal screening for trisomy 21 (Down's Syndrome) is based on a combination of maternal age, maternal serum biomarkers and fetal ultrasonic findings. Such screening can identify 70-90% of fetuses with trisomy 21".


Only a minority of cfDNA in maternal plasma comes from the placenta (fetal component - which is not always possible to obtain), and many studies of its use today have been exclusively confined to high risk pregnancies.


A large cfDNA study for trisomy 21 of approximately 16,000 unselected pregnancies with known outcomes strongly suggests good efficacy (positive predictive value: 80.9%) in all women seeking screening for trisomy 21 (false positives may support the need for invasive testing).


New England Journal of Medicine 

Demographics and risk factors/outcomes of children with febrile Status Epilepticus (SE).   

SE with fever is common and may result in neurological sequela.


A review of 253 children (1 month - 15 years) with a SE associated febrile episode indicates that few die (1.2%) during hospitalization and 12.6% have poor outcomes; associated risk factors for brain injury include absence of epilepsy history, body temperature >40C and impaired consciousness 12 hours after onset.


Pediatric Neurology 

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